1699883066 NPI number — JANS DISCOUNT PHARMACY INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699883066 NPI number — JANS DISCOUNT PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JANS DISCOUNT PHARMACY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LAKES DISCOUNT PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699883066
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2300 HAGGERTY RD STE 1070
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST BLOOMFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48323-2185
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-668-1212
Provider Business Mailing Address Fax Number:
248-668-8453

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2300 HAGGERTY RD
Provider Second Line Business Practice Location Address:
STE 1070
Provider Business Practice Location Address City Name:
WEST BLOOMFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48323-2184
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-668-1212
Provider Business Practice Location Address Fax Number:
248-668-8453
Provider Enumeration Date:
08/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHAHINE
Authorized Official First Name:
KHALIL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PHARMACIST IN CHARGE
Authorized Official Telephone Number:
248-668-1212

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 5301010346 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2046777 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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